Pseudocyesis in an adolescent using the long-acting contraceptive Depo-Provera

Endocrinology and physiology of pseudocyesis

This literature review on pseudocyesis or false pregnancy aims to find epidemiological, psychiatric/psychologic, gynecological and endocrine traits associated with this condition in order to propose neuroendocrine/endocrine mechanisms leading to the emergence of pseudocyetic traits. Ten women from 5 selected studies were analyzed after applying stringent criteria to discriminate between cases of true pseudocyesis (pseudocyesis vera) versus delusional, simulated or erroneous pseudocyesis. The analysis of the reviewed studies evidenced that pseudocyesis shares many endocrine traits with both polycystic ovarian syndrome and major depressive disorder, although the endocrine traits are more akin to polycystic ovarian syndrome than to major depressive disorder. Data support the notion that pseudocyetic women may have increased sympathetic nervous system activity, dysfunction of central nervous system catecholaminergic pathways and decreased steroid feedback inhibition of gonadotropin-releasing hormone. Although other neuroendocrine/endocrine pathways may be involved, the neuroendocrine/endocrine mechanisms proposed in this review may lead to the development of pseudocyetic traits including hypomenorrhea or amenorrhea, galactorrhea, diurnal and/or nocturnal hyperprolactinemia, abdominal distension and apparent fetal movements and labor pains at the expected date of delivery.

Pseudocyesis in a rural southeast Nigerian community

CONTEXT

Pseudocyesis is uncommon and probably under reported among the African population.

AIMS AND OBJECTIVES

To document the incidence and presentation of false pregnancies in a Nigerian rural population.

METHODS

This involved a review of prospectively collected data on all patients who were diagnosed with pseudocyesis over a four-year period in a Mission hospital.

RESULTS

Pseudocyesis occurred at a frequency of 1 in 344 pregnancies. The mean age was 33.6 years and the condition was found more commonly among poorly educated women. Amenorrhea was common among the subjects and 54% claimed they felt fetal movement. Ultrasound studies confirmed the absence of pregnancies in all cases. Management included counseling and referral to specialist clinical psychologists.

CONCLUSION

Pseudocyesis is more common among the African population than in developed countries. Gynaecologists in these regions should have a high index of suspicion to diagnose this and assess the mental status of the subject and the precipitating factors.

Limb pain associated with an undiagnosed hemoglobinopathy and pseudononcyesis

Over a 2-month period, a 16-yr-old African-American female presented with recurrent episodes of severe, migratory limb pain. Sickle cell C disease was ultimately diagnosed. She adamantly denied sexual activity but was found to be 28 weeks pregnant. Her limb pain was probably triggered by the metabolic and hemodynamic demands of pregnancy. The case illustrates the importance of thoroughly examining patients with recurrent, unexplained physical complaints.